Provider Demographics
NPI:1669685863
Name:REEVES, CECILY DIAN (FNP, PHD)
Entity Type:Individual
Prefix:MS
First Name:CECILY
Middle Name:DIAN
Last Name:REEVES
Suffix:
Gender:F
Credentials:FNP, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 BLACKSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1354
Mailing Address - Country:US
Mailing Address - Phone:415-492-8072
Mailing Address - Fax:415-479-7149
Practice Address - Street 1:3100 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3412
Practice Address - Country:US
Practice Address - Phone:415-686-1115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA257818363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner